II. Symptoms

  1. Sudden sharp Chest Pain
  2. Air Hunger

III. Signs

  1. Unilateral absent breath sounds
  2. Hyperresonant chest to percussion
  3. Cyanosis
  4. Respiratory distress
  5. Tachycardia
  6. Hypotension
  7. Tracheal deviation to contralateral side
  8. Neck vein distention

IV. Imaging: Chest XRay

  1. Do not use XRay to diagnose a Tension Pneumothorax
  2. Confirm diagnosis by Chest XRay after decompression

V. Differential Diagnosis

VI. Precautions

  1. Tension Pneumothorax is a clinical diagnosis (not an imaging diagnosis)
  2. Do not obtain a Chest XRay prior to needle decompression (delays are lethal)
  3. Needle decompression buys a small amount of time in which to place a Chest Tube for definitive management

VII. Management

  1. Emergent Needle Thoracentesis
    1. Do not wait for Chest XRay
    2. Use 14 gauge (5 cm long) angiocatheter in children and 10 gauge (7.5 cm long) angiocatheter in adults
    3. Insert angiocatheter over the top of the third rib in the mid-clavicular line
  2. Chest Tube
    1. Perform immediately after needle decompression
    2. Insert over the top of the 5th rib in the mid-axillary line

VIII. References

  1. (2012) ATLS 9th ed, American College of Surgeons, Committee on Trauma, p. 96-9

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Related Studies

Ontology: Tension Pneumothorax (C0264558)

Concepts Disease or Syndrome (T047)
MSH D011030
SnomedCT 155611004, 233645004, 76537003
Dutch spanningspneumothorax
French Pneumothorax sous tension
German Spannungspneumothorax
Italian Pneumotorace a valvola
Portuguese Pneumotórax de tensão
Spanish Neumotórax a tensión, neumotórax a tensión (trastorno), neumotórax a tensión
Japanese 緊張性気胸, キンチョウセイキキョウ
English tension pneumothorax (diagnosis), tension pneumothorax, pneumothorax tension, Pneumothoraxs, Tension, Pressure Pneumothoraxs, Pressure Pneumothorax, Pneumothorax, Tension, Pneumothoraxs, Pressure, Tension Pneumothorax, Tension Pneumothoraxs, Pneumothorax, Pressure, Tension pneumothorax, Tension pneumothorax (disorder)
Czech Tenzní pneumotorax
Hungarian Tensiós pneumothorax